Declining ACA Enrollment Trends in Kentucky and Idaho Raise Affordability Concerns
A recent analysis through April 2023 reveals a concerning trend of policy cancellations under the Affordable Care Act (ACA), driven primarily by non-payment issues. States like Kentucky and Idaho are experiencing significant enrollment declines, raising affordability concerns as the midterm elections approach.
Kentucky witnessed a dramatic increase in individuals losing coverage due to non-payment, with Idaho experiencing a significant enrollment drop of 24,402 during Q1, compared to 15,866 in the same period last year. In California, policy cancellations rose by 6%.
ACA plan enrollment totalled approximately 23 million in 2026, marking a 5% decline from the previous year. This decrease aligns with the cessation of pandemic-related subsidies that once bolstered affordability. Without these subsidies, premiums surged by an average of 114%, reaching $1,905 annually according to the Kaiser Family Foundation (KFF).
Matt McGough, a policy analyst at KFF, highlighted that consumers are now facing the full brunt of premium costs, prompting many to exit the marketplace. Despite efforts, the U.S. Centers for Medicare & Medicaid Services have not commented on this trend.
Increased Voter Concerns:
Professor Jonathan Oberlander of the University of North Carolina School of Medicine noted that health insurance affordability is increasingly capturing voter attention. KFF polling confirms affordable healthcare as a major public concern, alongside rising gasoline and transportation costs, significantly influencing independent voter decisions.
In Idaho, an insurance exchange representative pointed to affordability as a key factor in increased disenrollments. The Wakely Consulting Group's analysis indicates a 17% to 26% drop in overall ACA enrollment, with over 14% failing to pay January premiums, consistent with KFF data.
Among the 20 states and the District of Columbia contacted for insights, 12 reported significant non-payment-related losses. States like Connecticut, Massachusetts, and New Mexico highlighted similar trends. While the standard grace period for delinquencies spans 90 days or more, Kentucky's coverage losses exceeded 15,000 from January to April.
Restricted insurance competition in rural areas, noted by McGough, contributes to higher premiums in Kentucky and Idaho. Conversely, state-based support in Colorado resulted in lower disenrollment rates, while Maryland anticipates a 15% enrollment drop this year.
Michele Eberle, Executive Director of Maryland’s Health Benefit Exchange, stated, "We're going to see month-over-month declines, especially with gas prices continuing to climb. We have to see where the breaking point is for people."